Why we need (some) government in health care reform

Look, I’m all for more decentralized solutions to health care, but the government simply needs to play a role in setting the rules.  Rick Ungar provides at least one good reason why that is.

Ian Pearl is a 37 year old victim of muscular dystrophy, confined to a wheel chair and only able to breathe with the assistance of the tube in his throat connecting him to his ventilator.

With all of the obvious challenges in Ian’s life, he’s been fortunate. Thanks to a small business health insurance policy purchased by Mr. Pearl’s father from Guardian Life Insurance Co., Ian’s medical expenses – which run about $1 million annually -have been covered by his policy.

But Ian’s luck appears to have run out.

Barred from discriminating against individuals who submit large claims for payment, Guardian has opted to simply cancel the lines of insurance that provide the coverage Ian needs in all the various states where they do business – all just to avoid paying for Ian’s care.

But wait, there’s more….

Even if the system relies entirely on competitive, for-profit insurers, there should be rules against this sort of thing, and if anything comes of this current health reform process, I hope it’s the inability for insurers to deny coverage based on pre-existing conditions, and to relinquish coverage based on technicalities, or using dirty tricks like this to save a buck.

The status quo isn’t right or fair or even civilized.  We can do better.

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4 thoughts on “Why we need (some) government in health care reform

  1. I’m sure that there is a legal explanation for why this type of practice is not murder, but it’s lost on me. I sometimes feel for the underlings who make these decisions in insurance companies, slowly turning themselves into sociopaths for a paycheck.

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  2. One thing that seems worth noting here, though. This would be a straightforward common law breach of contract claim were it not for the fact that ERISA preempts breach of contract claims and specifically created the rule allowing for this type of end-run around basic principles of contract law. So in no small part this case is an example of government creating ground rules that were specifically created to allow insurance companies to screw their policyholders in new and interesting ways. Now, if repealing ERISA is not on the table, obviously you need to implement new regulations that prohibit this. But the role of regulation in creating this problem in the first place should be noted nonetheless.

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